低分子肝素治疗不稳定型心绞痛临床观察

Clinical observation of low molecular weight heparin in the treatment of unstable angina

目的比较低分子肝素和普通肝素治疗不稳定性心绞痛的疗效。方法43例符合不稳定性心绞痛诊断标准的患者分为治疗组和对照组。对照组在常规治疗基础上先静脉滴注普通肝素5000U，然后以1000U／h维持静脉滴注，调整肝素剂量使激活的部分凝血酶原时间（aPTT）延长至参考值的1．5～2倍，连续使用7d；治疗组在常规治疗基础上加用低分子肝素钙4100U皮下注射，012h，连续使用7d。观察两组治疗前后心绞痛发作的次数、持续时间，心电图变化，凝血指标，出血情况等。结果两组均能显著减少心绞痛发作频率及持续时间，减少缺血负荷（P〈0．01），但治疗组与对照组在治疗后相比有统计学差异（P〈0．05）。治疗组对凝血指标无明显影响（P〉0．05），而对照组对凝血指标有统计学意义。结论普通肝素与低分子肝素对不稳定性心绞痛的治疗作用相似，但低分子肝素作用更为明显，使用安全、方便。

Objective To compare curative effects of low molecular weight heparin and ordinary heparin in the treatment of unstable angina. Methods Forty-three patients with unstable angina corresponding to diagnosis criteria were divided into treatment group and control group on the basis of conventional treatment. On the basis of conventional treatment, at first the control group was given intravenous ordinary heparin 5000U, then ordinary dose was maintained in dose of 1000U/h and continuously adjusted.When activate part of prothrombin time （aPTT） reached up 1.5- 2 times of the normal reference value, maintained for seven days. The treatment group was given routine treatment and low molecular weight heparin calcium 4100U subcutaneously Q12h, for 7 days. The number of anginal attack, duration, ECG changes, coagulation and hemorrhage index before and after treatment were observed. Results The anginal attack freguency and duration, ischemia load in two groups signifieantly reduced（ P 〈 0.01 ） ,but after treatment, there was significant difference between treatment group and control group（ P 〈 0.05）. The change of coagulation index in the treatment group was no obvious（P 〉0.05）, but the change of coagulation index in the control group was statistically significant（ P 〈 0.01 ）. Conclusion The efficacy of ordinary heparin and low molecular weight heparin is similar, but low molecular weight heparin is more obvious effective, simple and safe with low side effects.